| NPI | 1699828475 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THAI T PHAN President 336-659-9045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 28930) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 28930) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 28930) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2008-08-01 |